With patients having more financial responsibility for their healthcare, outpatient settings like ambulatory surgery centers are becoming more attractive to patients. A research report from Bain & Co. estimates that the number of procedures taking place in outpatient surgery centers will rise from 23 million in 2018 to 27 million in 2021. As per the same report, out of all outpatient surgeries done in the year 2017, half were performed by ASCs. Now as things are settling down after the corona pandemic, these numbers are again looking realistic. Before getting prepared for this growth potential, you have to streamline your current ASC billing process. In this blog, we discussed Ambulatory Surgical Center (ASC) billing challenges and ways to counter them. We are confident that these tips will help in improving your Ambulatory Surgical Center (ASC) collections.
Tips for Ambulatory Surgical Center to Improve the Patient Collections Process
Always Take Prior-Authorization
Prior to the date of surgery, always verify eligibility and benefits to understand coverage and determine the party responsible for payment. Always call the insurance company and as per your discussion with the insurance representative, if required, obtain prior authorization. Obtain pre-determination if prior authorization is not required. An insurance company may not process the pre-determination request, try to take approval for pre-determination based on medical necessity. In absence of prior authorization, an insurance company may not pay for offered services. Prior authorization is such a key element of ASC billing that you should have a dedicated team for doing eligibility verification and prior authorization.
Focus on Out-of-Network Billing
The best option in out-of-network billing is to call an insurance representative and ask specific questions about insurance coverage to determine the case’s profitability. If the payer is UHC, ask if it is a maximum non-network reimbursement plan and if payment is based on the Medicare fee schedule. If the payer is Aetna, ask if payment is based upon reasonable and customary fees or the Medicare fee schedule. Pre-negotiate coverage with adjusters for any uncovered procedures and/or implant(s) and also ensure that you will get commitments in writing. Creating a hybrid out-of-network and in-network strategy will help in improving your ambulatory surgical center collections.
Track Unpaid Claims
Always track the claims and even after thirty days if the claim is unpaid then start taking follow-up and find the root cause. Understand how the claims were processed, it may be unpaid because everything was applied towards the patients out of network responsibility. Some of the common reasons for a claim to remain as unpaid are followed:
- Payments might be sent to the patient
- The claim may not be denied, it just got rejected due to coding or billing errors or due to lack of documentation
- No prior authorization was taken
- Appeal claims that were inappropriately processed i.e., in-network versus out of network usual and customary fees
- Need to respond to Medicare records requests
Poor Payer Contracting
Ambulatory surgery center (ASC) administrators face a variety of challenges when it comes to successfully managing their payer contract negotiations. But with careful preparation, ASC administrators can keep more money to reward and boost ASC growth by negotiating payer contracts. Some of payer contracting tips are as follows:
- Medicare has been making a series of significant adjustments causing sizable reimbursement changes, it’s important to negotiate upfront for ample room in the budget for contractual changes to occur.
- Perform a comparison of the proposed contract to other third-party payer and Medicare rates. When contracts are renegotiated, consider new procedures to be added, increase in supply costs, and other factors that can improve reimbursement.
- Always check the term of the contract and, if a payer is requesting a three-year contract, be certain to get cost of living adjustments incorporated in the 2nd and 3rd years.
- Do not overlook procedures that use expensive implants. If the payer does not separately cover implants, make sure to ask for carve-outs, especially for higher-cost cases.
Track Key Performance Indicators
Tracking KPIs keeps surgery center staff accountable and motivated. If you are evaluating these KPIs on a daily, weekly, and monthly basis, it will definitely help in improving your Ambulatory Surgical Center (ASC) collections. Managing following KPIs regularly will lead to simplified goal-setting for staff.
- Accounts Receivable (AR) days: Surgery centers will want to look at data showing how quickly they are paid. The longer your money sits out on your aging AR, the harder it is to collect. A surgery center’s KPI of AR days partly depends on its payer mix.
- Net collection percentage: The net collection percent should be 95% or higher. This KPI should be observed over a 12-month period to determine an average, rather than looking only at one month.
- Bad debt: Bad debt should be less than 1% of net revenue. We don’t want to write off any more than 1% of actual revenue each month.
- Clean claim rates: Ideally clean claim submission rate should not be less than 95%. It will help you to track front office errors, demographics issues, missed authorizations, incorrect patient identifiers, expired eligibility, coding errors, incorrect bundling of codes, non-utilized fees, incorrect codes, untimely filing, missed appeals deadline, duplicate claims, and out-of-network claims, and other billing errors.
MedicalBillersandCoders (MBC) offers complete transparency and control of the ASC revenue cycle along with key analytics, actionable insights, recommendations, and proven strategies. Such offerings will maximize the ASC’s efficiency, profitability, and physician disbursements. To know more about Ambulatory Surgical Center (ASC) medical billing and coding services contact us at email@example.com/888-357-3226